{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T06:24:43Z","timestamp":1763101483475,"version":"3.45.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T00:00:00Z","timestamp":1763078400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background and purpose<\/jats:title>\n                    <jats:p>Vertebrobasilar artery occlusion (VBAO) is a rare yet severe type of ischemic stroke, often leading to respiratory failure that necessitates invasive mechanical ventilation and is associated with high mortality rates. While endovascular treatment (EVT) has improved outcomes for VBAO, many patients still require prolonged mechanical ventilation (PMV) post-EVT, further increasing mortality and posing challenging decisions for families. Currently, no predictive model exists to identify VBAO patients at risk of needing PMV after EVT. This study aims to develop and validate a predictive score for PMV in this patient population following EVT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>The derivation cohort prospectively recruited VBAO patients undergoing EVT from four comprehensive stroke centers (CSCs) in China. PMV was defined as continuous mechanical ventilation lasting for \u22657\u202fdays. Multivariable logistic regression was conducted to develop a scoring system. The performance of the model was evaluated for discrimination, calibration, and clinical utility. Four hundred and fourteen patients from acute Posterior circulation ischemic Stroke registry were enrolled to externally validate the model. Sensitivity analysis redefined PMV as using mechanical ventilation last for \u2265 14\u202fdays to further validate the model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The derivation cohort consisted of 419 patients from four CSCs, among whom 113 (27.0%) required PMV. The presence of malignant cerebellar edema, posterior circulation collateral status, symptomatic intracranial hemorrhage post-EVT, atrial fibrillation, intravenous thrombolsis, vasopressor therapy and Glasgow coma score classification are found to be independent predictors of PMV in logistic regression, then \u2018AIRFLOW\u2019 scoring system was created. The AIRFLOW score demonstrated good discrimination in derivation cohort (C-index, 0.85, 95% CI 0.81 to 0.89), as well as the validation cohort (C-index, 0.82, 95% CI 0.77 to 0.86). Calibration plots and decision curve analysis for AIRFLOW score indicated that the model accurately predicted the risk of PMV and had satisfactory net benefit across various thresholds. Similar results were found in sensitivity analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The AIRFLOW score may help predict PMV in VBAO patients after EVT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2025.1673616","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T06:22:17Z","timestamp":1763101337000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Predicting prolonged mechanical ventilation after endovascular treatment for acute vertebrobasilar artery occlusion: AIRFLOW score"],"prefix":"10.3389","volume":"16","author":[{"given":"Qiankun","family":"Cai","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minying","family":"Hong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yingjie","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuai","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhixin","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pengfei","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunnuan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jixing","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lichao","family":"Ye","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1002","DOI":"10.1016\/s1474-4422(11)70229-0","article-title":"Basilar artery occlusion","volume":"10","author":"Mattle","year":"2011","journal-title":"Lancet Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1016\/s1474-4422(09)70173-5","article-title":"Treatment and outcomes of acute basilar artery occlusion in the basilar artery international cooperation study (BASICS): a prospective registry study","volume":"8","author":"Schonewille","year":"2009","journal-title":"Lancet Neurol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2638","DOI":"10.1161\/strokeaha.117.017794","article-title":"Use and timing of tracheostomy after severe stroke","volume":"48","author":"B\u00f6sel","year":"2017","journal-title":"Stroke"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1161\/01.str.27.8.1301","article-title":"Outcome in patients with acute basilar artery occlusion requiring mechanical ventilation","volume":"27","author":"Wijdicks","year":"1996","journal-title":"Stroke"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/s0140-6736(24)01820-8","article-title":"Endovascular therapy for acute vertebrobasilar occlusion (VERITAS): a systematic review and individual patient data meta-analysis","volume":"405","author":"Nogueira","year":"2025","journal-title":"Lancet"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.1007\/s12028-020-01125-9","article-title":"Prevalence, predictors, and outcomes of prolonged mechanical ventilation after endovascular stroke therapy","volume":"34","author":"Saber","year":"2021","journal-title":"Neurocrit Care"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1136\/neurintsurg-2021-018003","article-title":"Influence of renal impairment on clinical outcomes after endovascular recanalization in vertebrobasilar artery occlusions","volume":"14","author":"Xiao","year":"2022","journal-title":"J Neurointerv Surg"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"17562864221114627","DOI":"10.1177\/17562864221114627","article-title":"The safety and effectiveness of endovascular treatment for patients with vertebrobasilar artery occlusions: according to the BEST and BASICS criteria","volume":"15","author":"Sun","year":"2022","journal-title":"Ther Adv Neurol Disord"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e270","DOI":"10.1136\/jnis-2022-019437","article-title":"Effects of admission systemic inflammatory indicators on clinical outcomes in patients with vertebrobasilar artery occlusion: insight from the PERSIST registry","volume":"15","author":"Zhang","year":"2023","journal-title":"J Neurointerv Surg."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1183\/09031936.00010206","article-title":"Weaning from mechanical ventilation","volume":"29","author":"Boles","year":"2007","journal-title":"Eur Respir J"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"2485","DOI":"10.1161\/strokeaha.107.511162","article-title":"Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion","volume":"39","author":"Puetz","year":"2008","journal-title":"Stroke"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1161\/strokeaha.116.015492","article-title":"The basilar artery on computed tomography angiography prognostic score for basilar artery occlusion","volume":"48","author":"Alemseged","year":"2017","journal-title":"Stroke"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e109","DOI":"10.1161\/01.Str.0000082721.62796.09","article-title":"Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke","volume":"34","author":"Higashida","year":"2003","journal-title":"Stroke"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"2981","DOI":"10.1161\/strokeaha.115.010049","article-title":"The Heidelberg bleeding classification: classification of bleeding events after ischemic stroke and reperfusion therapy","volume":"46","author":"von Kummer","year":"2015","journal-title":"Stroke"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1093\/neuros\/nyaa438","article-title":"Early prediction of malignant cerebellar edema in posterior circulation stroke using quantitative lesion water uptake","volume":"88","author":"Broocks","year":"2021","journal-title":"Neurosurgery"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"3060","DOI":"10.1161\/strokeaha.109.550913","article-title":"Long-term outcome after surgical treatment for space-occupying cerebellar infarction: experience in 56 patients","volume":"40","author":"J\u00fcttler","year":"2009","journal-title":"Stroke"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1503","DOI":"10.1007\/s00134-019-05801-z","article-title":"Vasopressor therapy in critically ill patients with shock","volume":"45","author":"Russell","year":"2019","journal-title":"Intensive Care Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1097\/ccm.0000000000005189","article-title":"Factors associated with prolonged mechanical ventilation in patients with subarachnoid hemorrhage-the RAISE score","volume":"50","author":"Rass","year":"2022","journal-title":"Crit Care Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1631","DOI":"10.1002\/sim.1742","article-title":"Presentation of multivariate data for clinical use: the Framingham study risk score functions","volume":"23","author":"Sullivan","year":"2004","journal-title":"Stat Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1007\/s12028-015-0235-5","article-title":"The SET score to predict tracheostomy need in cerebrovascular Neurocritical care patients","volume":"25","author":"Sch\u00f6nenberger","year":"2016","journal-title":"Neurocrit Care"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1007\/s12028-011-9567-y","article-title":"Withdrawal of life-sustaining treatment in a mixed intensive care unit: most common in patients with catastropic brain injury","volume":"16","author":"Verkade","year":"2012","journal-title":"Neurocrit Care"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"3937","DOI":"10.1378\/chest.128.6.3937","article-title":"Management of patients requiring prolonged mechanical ventilation: report of a NAMDRC consensus conference","volume":"128","author":"MacIntyre","year":"2005","journal-title":"Chest"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1483","DOI":"10.1001\/jama.2011.1413","article-title":"Time-limited trials near the end of life","volume":"306","author":"Quill","year":"2011","journal-title":"JAMA"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1007\/s12975-020-00833-w","article-title":"Analysis of treatment outcome after endovascular treatment in different pathological subtypes of basilar artery occlusion: a single center experience","volume":"12","author":"Sun","year":"2021","journal-title":"Transl Stroke Res"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1002\/acn3.536","article-title":"Impact of stroke mechanism in acute basilar occlusion with reperfusion therapy","volume":"5","author":"Lee","year":"2018","journal-title":"Ann Clin Transl Neurol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1136\/svn-2021-001242","article-title":"Endovascular treatment with or without intravenous alteplase for acute ischaemic stroke due to basilar artery occlusion","volume":"7","author":"Nie","year":"2022","journal-title":"Stroke Vasc Neurol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"3241","DOI":"10.1161\/strokeaha.115.010721","article-title":"Alteplase reduces downstream microvascular thrombosis and improves the benefit of large artery recanalization in stroke","volume":"46","author":"Desilles","year":"2015","journal-title":"Stroke"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1111\/ene.13330","article-title":"Impact of intravenous thrombolysis on recanalization rates in patients with stroke treated with bridging therapy","volume":"24","author":"Mueller","year":"2017","journal-title":"Eur J Neurol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1161\/circulationaha.121.056554","article-title":"Association between endovascular therapy time to treatment and outcomes in patients with basilar artery occlusion","volume":"145","author":"Joundi","year":"2022","journal-title":"Circulation"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1097\/aln.0000000000001725","article-title":"Extubation success prediction in a multicentric cohort of patients with severe brain injury","volume":"127","author":"Asehnoune","year":"2017","journal-title":"Anesthesiology"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1673616\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T06:22:18Z","timestamp":1763101338000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1673616\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,14]]},"references-count":30,"alternative-id":["10.3389\/fneur.2025.1673616"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1673616","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,14]]},"article-number":"1673616"}}